Back to top
Short SAS Name
PRPAY_CD
SAS Name
NCH_PRMRY_PYR_CD

The code, on an institutional claim, specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's health insurance bills.

The presence of a primary payer code indicates that some other payer besides Medicare covered at least some portion of the charges.

Comments

Source: NCH

Values C, M, N, Y, Z and BLANK indicate Medicare is primary payer. (values Z and Y were used prior to 12/90. BLANK was supposed to be effective after 12/90, but may have been used prior to that date.)
CodeCode value
A
Employer group health plan (EGHP) insurance for an aged beneficiary
B
EGHP insurance for an end-stage renal disease (ESRD) beneficiary
C
Conditional payment by Medicare; future reimbursement from the Public Health Service (PHS) expected
D
No fault automobile insurance
E
Workers' compensation (WC)
F
Public Health Service (PHS) or other Federal agency (other than VA)
G
Working disabled beneficiary under age 65 with a local government health plan (LGHP)
H
Black Lung (BL) program
I
Department of Veteran's Affairs
L
Any liability insurance
M
Override EGHP - Medicare is primary payer
N
Override non-EGHP - Medicare is primary payer
Blank / missing
No other primary payer